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1.
Plast Reconstr Surg ; 145(2): 303-311, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985608

RESUMO

BACKGROUND: The authors compared long-term health care use and cost in women undergoing immediate autologous breast reconstruction and implant-based breast reconstruction. METHODS: This study was conducted using the OptumLabs Data Warehouse, which contains deidentified retrospective administrative claims data, including medical claims and eligibility information from a large U.S. health insurance plan. Women who underwent autologous or implant-based breast reconstruction between January of 2004 and December of 2014 were included. The authors compared 2-year use rates and predicted costs of care. Comparisons were tested using the t test. RESULTS: Overall, 12,296 women with immediate breast reconstruction were identified; 4257 with autologous (35 percent) and 8039 with implant-based (65 percent) breast reconstruction. The proportion of autologous breast reconstruction decreased from 47.2 percent in 2004 to 32.7 percent in 2014. The mean predicted reconstruction cost of autologous reconstruction was higher than that of implant-based reconstruction in both unilateral and bilateral surgery. Similar results for mean predicted 2-year cost of care were seen in bilateral procedures. However, in unilateral procedures, the 2-year total costs were higher for implant-based than for autologous reconstruction. Two-year health care use rates were higher for implant-based reconstruction than for autologous reconstruction for both unilateral and bilateral procedures. Women undergoing unilateral implant-based reconstruction had higher rates of hospital admissions (30.3 versus 23.1 per 100; p < 0.01) and office visits (2445.1 versus 2283.6 per 100; p < 0.01) than those who underwent autologous reconstruction. Emergency room visit rates were similar between the two methods. Bilateral procedures yielded similar results. CONCLUSION: Although implant-based breast reconstruction is a less expensive index operation than autologous breast reconstruction, it was associated with higher health care use, resulting in similar total cost of care over 2 years.


Assuntos
Implante Mamário/métodos , Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Adolescente , Adulto , Assistência Ambulatorial/economia , Assistência Ambulatorial/estatística & dados numéricos , Implante Mamário/economia , Implantes de Mama/economia , Implantes de Mama/estatística & dados numéricos , Neoplasias da Mama/economia , Custos e Análise de Custo , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Mamoplastia/economia , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante Autólogo/economia , Transplante Autólogo/estatística & dados numéricos , Estados Unidos , Adulto Jovem
2.
Z Evid Fortbild Qual Gesundhwes ; 146: 28-34, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31570212

RESUMO

INTRODUCTION AND AIM: The ambulatory specialized care (ASV) act (Sect. 116b of the Social Code Fifth Book [SGB V]) is intended to enable patients with a rare disease or a special course of disease or patients needing a highly specialized treatment to get access to outpatient care by office-based as well as hospital doctors. Data concerning care, service performance and fees - in comparison to the usual contract with the statutory insurance or the former Sect. 116b SGB V - are lacking. We explored the question whether differences in reimbursement between ASV and the previous system exist and which factors are influencing them. METHODS: We analyzed ICD-10 diagnoses, performance parameters as well as budgets and service fees in the former care system of medical oncologists in the institutions of three ASV participants of two federal countries treating gastrointestinal malignancies. We compared the results (fees, remuneration) to those from the statutory contract system and the former ambulatory care of hospitals and calculated the differences. Data were analyzed descriptively and analytically using SPSS. RESULTS: The analyses showed significant differences in the reimbursement rates between both office-based teams due to different budgets in the statutory contract system of the different federal countries. This led to additional remuneration of 12.5 to 49 % in ASV. The increase in fees of the hospital-guided team was exclusively due to the ASV-only fees of chapter 51 of EBM since there were no limitations of budgets even in the former system. DISCUSSION AND CONCLUSION: Exemplified with the ASV subgroup GIT, our study shows for the analyzed medical specialty that the difference in reimbursement in ASV is mostly due to the federal country-specific budgets and that the increase in honoraria can be substantial. Due to differences in budgets and quota systems, there may be different results in other ASV indications and specialist groups as well as in other federal states. Irrespective of these arguments, further aspects need to be taken into account when participation in ASV is considered.


Assuntos
Instituições de Assistência Ambulatorial/economia , Neoplasias Gastrointestinais , Custos de Cuidados de Saúde , Reembolso de Seguro de Saúde , Assistência Ambulatorial/economia , Custos e Análise de Custo , Neoplasias Gastrointestinais/economia , Alemanha , Humanos , Oncologia , Mecanismo de Reembolso , Especialização
3.
BMC Health Serv Res ; 19(1): 626, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481056

RESUMO

BACKGROUND: Regional variation in medical care costs can indicate heterogeneity in clinical practice, inequities in access, or inefficiencies in service delivery. We aimed to estimate regional variation in medical costs for people living with HIV (PLHIV), adjusting for demographics and case-mix. METHODS: We conducted a retrospective cohort study using linked health administrative databases of PLHIV, from 2010 to 2014, in British Columbia (BC), Canada. Quarterly health care costs (2018 CAD) were derived from inpatient, outpatient, prescription drugs, antiretroviral therapy (ART), and HIV diagnostics. We used a two-part model with a logit link for the probability of incurring costs, and a log link and gamma distribution for observations with positive costs. We also estimated quarterly utilization rates for hospitalization-, physician billing- and prescription drug-days. Primary variables were indicators of individuals' Health Service Delivery Area (HSDA). We adjusted cost and utilization estimates for demographic characteristics, HIV-disease progression, and comorbidities. RESULTS: Our cohort included 9577 PLHIV (median age 45.5 years, 80% male). Adjusted total quarterly costs for all 16 HSDAs were within 20% of the provincial mean, 8/16 for hospitalization costs, 16/16 for physician billing costs and 10/16 for prescription drug costs. Northern Interior and Northeast HSDAs had 38 and 44% lower quarterly non-ART prescription drug costs, and 2 and 5% higher quarterly inpatient costs, respectively. CONCLUSIONS: We observed limited variation in medical care costs and utilization among PLHIV in BC. However, lower levels of outpatient care and higher levels of inpatient care indicate possible barriers to accessing care among PLHIV in the most rural regions of the province.


Assuntos
Fármacos Anti-HIV/economia , Infecções por HIV/economia , Adulto , Assistência Ambulatorial/economia , Fármacos Anti-HIV/uso terapêutico , Colúmbia Britânica/epidemiologia , Estudos de Coortes , Comorbidade , Bases de Dados Factuais , Progressão da Doença , Custos de Medicamentos , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Medicamentos sob Prescrição/uso terapêutico , Características de Residência , Estudos Retrospectivos , Saúde da População Rural
4.
Schmerz ; 33(5): 384-391, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31473816

RESUMO

BACKGROUND: Geriatric patients often suffer from a long history of pain and have a limited life expectancy. Cannabinoid receptor agonists like dronabinol may be an effective, low-risk treatment option for geriatric patients with chronic pain. OBJECTIVES: The effectiveness and side effects of dronabinol therapy in geriatric patients are analyzed. The effects of the approval requirement are presented. METHODS: In our retrospective monocentric cohort study, the study population comprised all geriatric patients over the age of 80 years who were treated in our office since the cannabis law came into effect on 10 March 2017 until 17 July 2018 (evaluation date). Geriatric, nonpalliative pain patients (group A) and geriatric palliative patients (group B) were investigated. The basis of the evaluation was a questionnaire sheet that we use in our office with details of dosages, pain intensity, treatment effects and side effects from dronabinol therapy. RESULTS: By using dronabinol, 21 of the 40 geriatric patients (52.5%) achieved pain relief of more than 30%, 10% of the patients of more than 50%. On average, about four symptoms or side effects related to previous treatment were positively influenced. 26% of patients reported side effects. The rejection rates on the part of the health insurances were 38.7% (group A) and 10.3% (group B). CONCLUSIONS: This study is one of the few analyses of the use of Dronabinol in geriatric patients. We show that cannabis-based drugs (in this case dronabinol) are an effective, low-risk treatment option that should be considered early in therapy. Regarding the indication spectrum, further clinical studies and an approval-free test phase are necessary.


Assuntos
Assistência Ambulatorial , Dronabinol , Dor , Cuidados Paliativos , Idoso , Assistência Ambulatorial/economia , Assistência Ambulatorial/normas , Estudos de Coortes , Dronabinol/uso terapêutico , Humanos , Dor/tratamento farmacológico , Cuidados Paliativos/economia , Cuidados Paliativos/normas , Estudos Retrospectivos
5.
Am J Disaster Med ; 14(1): 65-70, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31441029

RESUMO

CONTEXT: The threat of terrorism is intensifying with a recent rise in the number of death and injuries. Nevertheless, few articles deal with the short and long-term medical costs of treating and assisting the civilian victims of terror. The objective of this article is to review the literature and describe the medical costs of supporting victims of terrorism. METHOD: The authors reviewed the literature on the medical costs following terror attacks in the PubMed/Medline and Google Web sites. Relevant scientific articles, textbooks, and global reports were included in the research. RESULTS: There was a scarcity of data related to the medical costs of terror. The authors review the few articles that describe the hospital and outpatient expenses. The terror attacks lead to increasing length of stay and the use of supplementary medical support. The authors detail the relevant global reports and working papers on terrorism that included the cost of injury and the over-all economic impact assessment. CONCLUSION: The medical costs result from hospital and outpatient treatment support. There is a clear need to track the long-term fate of the victims of terror. The authors recommend that future research should include all sectors of the healthcare system, including the whole rehabilitation process and have a precise tracking system for all victims.


Assuntos
Assistência Ambulatorial/economia , Vítimas de Crime/economia , Vítimas de Crime/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Serviços de Saúde Mental/economia , Terrorismo/economia , Assistência Ambulatorial/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitais , Humanos , Israel , Serviços de Saúde Mental/estatística & dados numéricos , Terrorismo/estatística & dados numéricos
6.
J Pak Med Assoc ; 69(Suppl 2)(6): S2-S9, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31369528

RESUMO

Objectives: To estimate the economic burden of asthma treatment by quantifying direct medical expenditures at one of Southern Vietnam's public hospitals base on the hospital perspective. Methods: A retrospective, prevalence-based, cost-of-illness analysis was developed using the hospital's electronic medical record data to calculate the economic burden of asthma (ICD-10 code J45, J46) through direct medical costs from January 2014 to December 2017. All costs were converted to US dollars and to the year 2018. Data were analyzed using descriptive statistics. The potential correlations between variables were evaluated using the chisquare test and bootstrap difference. Results: The average direct medical cost of asthma was estimated to range from $34.7 to $55.3 per - outpatient and $45.1 to $107.2 per - inpatient annually. The total economic burdens for 4 years from 2014 to 2017 were $110,387.4 from outpatients and $13,413.8 from inpatients. The most influential component was medication cost. Conclusions: Asthma places a high economic burden on individuals and the healthcare system in Vietnam. The findings of this study provide health administrators with important evidence to enhance surveillance of the disease and to allow suitable drafting of national health policy.


Assuntos
Assistência Ambulatorial/economia , Antiasmáticos/economia , Asma/economia , Efeitos Psicossociais da Doença , Gastos em Saúde , Hospitalização/economia , Adolescente , Adulto , Antiasmáticos/uso terapêutico , Asma/terapia , Criança , Custos de Medicamentos , Feminino , Custos Hospitalares , Hospitais Públicos , Humanos , Seguro Saúde , Masculino , Estudos Retrospectivos , Espirometria/economia , Vietnã , Adulto Jovem
7.
J Pak Med Assoc ; 69(Suppl 2)(6): S28-S33, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31369531

RESUMO

Objectives: Eczema, which is synonymous with atopic eczema, is classified as a complex, chronic, and relapsing inflammatory skin condition, affecting both adults and children. However, there has not been any research into health-care expenditure to evaluate the medical cost of eczema from patients' perspective in Vietnam. This retrospective study aimed to fill in the gap concerning the medical cost of eczema treatment from patients' perspective. Methods: Data from Ho Chi Minh City Hospital of Dermato Venereology's electronic medical database on demographics and drug therapy from June 2016 to May 2017 were collected. The patients who met the study's criteria were included in the study and were then categorized as mild, moderate, and severe according to received treatment level. Bootstrapping methods were used to evaluate average and emphasized the difference of cost burden adjusted by factors. Results: A total of 6,212 patients (52.1% women and 85% urban residents) participated in the study; they were divided into three groups according to treatment stage: mild (n = 3,159, 50.9%), moderate (n = 599, 9.6%), and severe (n = 2,454, 39.5%). The evaluated total cost for the three groups was 5,255.82, 1,064.03, and 5,8154.60 US dollars, respectively; the average expenditure per patient per year was around $12.11 ($11.63-12.59). Conclusions: The results suggested that the estimated direct medical cost of eczema treatment was much lower than that in the Western countries, mostly because of insurance coverage. The findings provide useful insights into health economic evaluations and treatment costs of eczema in Vietnam.


Assuntos
Efeitos Psicossociais da Doença , Dermatite Atópica/economia , Gastos em Saúde , Adolescente , Corticosteroides/economia , Corticosteroides/uso terapêutico , Adulto , Idoso , Assistência Ambulatorial/economia , Criança , Pré-Escolar , Dermatite Atópica/tratamento farmacológico , Custos de Medicamentos , Eczema/economia , Emolientes/economia , Emolientes/uso terapêutico , Feminino , Hospitais Públicos , Humanos , Imunossupressores/economia , Imunossupressores/uso terapêutico , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Vietnã , Adulto Jovem
8.
J Pak Med Assoc ; 69(Suppl 2)(6): S34-S40, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31369532

RESUMO

Objective: Colorectal cancer (CRC) is the third most common, and the second deadliest, cancer documented in recent years, and numerous studies have addressed this issue. Nevertheless, little attention has been given to the CRC burden in Vietnam. Our study aims to analyze variations in cost for CRC treatments using the cost of illness (COI) method. Methods: Utilizing medical records spanning from 2014 to 2017 supplied by a primary healthcare facility in Ho Chi Minh City, a population of 9,126 patients, diagnosed with and treated for CRC, was analyzed in terms of demographic detail and individual treatment cost. Results: Among the 9,126 patients hospitalized with CRC, 3,699 patients were between the ages of 50 and 65. Colon cancer accounted for 56.4% and 60.4% of the total patients in Inpatient Department (IPD) and Outpatient Department (OPD). The total direct medical cost was calculated to be over ten million USD for IPD patients and over three million USD for OPD patients over a four year span of data. The per-patient cost was $2,741.00 (IPD) and $588.80 (OPD), with chemotherapy drugs being 53% (IPD) and 73% (OPD) of the overall treatment cost. Patients going through both treatment regimens incurred a mean cost of $4,271.20 (IPD) and $1,779.80 (OPD). Conclusions: There is a similarity in the costs of CRC treatment in developing countries in Asia. Despite many limitations, we are certain this study will be useful for future studies regarding the CRC burden in Asia in general, as well as in developing countries like Vietnam.


Assuntos
Assistência Ambulatorial/economia , Antineoplásicos/economia , Neoplasias Colorretais/economia , Efeitos Psicossociais da Doença , Procedimentos Cirúrgicos do Sistema Digestório/economia , Gastos em Saúde , Hospitalização/economia , Adulto , Idoso , Neoplasias Colorretais/terapia , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vietnã
9.
J Pak Med Assoc ; 69(Suppl 2)(6): S41-S48, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31369533

RESUMO

Objectives: Asthma is a disease that causes significant health and economic burdens worldwide. The prevalence and incidence of asthma have been rising around the world over recent decades. The current study is to capture the direct medical costs of inpatient and outpatient asthma treatment for the period from 2013 to 2017. Methods: This study was conducted at Military Hospital 175 in Vietnam. The study was performed from the patient and social insurance perspective, which means all types of costs were identified and measured based on patients' healthcare insurance. Cost analysis was measured using the medical records for estimating the economic burden of asthma. The study adopted descriptive statistics and bootstrap techniques to calculate asthma-related costs as well as analyze the background characteristics of asthma patients. Results: The average outpatient and inpatient costs were US$64.90 and US$141.20, respectively, over the period from 2013 to 2017, for which out-of-pocket payments accounted for 10-12%. Medications, specifically asthma controller drugs, were the key driver leading to the substantial burden of direct medical costs for treating asthma. The cost burden was also significantly higher for adult patients compared to children. Conclusions: Asthma continues to be a concerning problem in Vietnam. The economic impact of either preventive or promotive health interventions that can reduce the prevalence of asthma can be predicted from the statistics found in this research. Moreover, this data will help policymakers plan and allocate national expenditures for asthma treatment in a more rational way.


Assuntos
Assistência Ambulatorial/economia , Antiasmáticos/economia , Asma/economia , Hospitalização/economia , Hospitais Militares , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antiasmáticos/uso terapêutico , Asma/terapia , Criança , Pré-Escolar , Feminino , Custos de Cuidados de Saúde , Gastos em Saúde , Humanos , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vietnã , Adulto Jovem
10.
J Pak Med Assoc ; 69(Suppl 2)(6): S64-S74, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31369536

RESUMO

Objective: Chronic obstructive pulmonary disease (COPD) is associated with major burden on economic effects. The objective of this study was to explore cost categories caused by COPD in Vietnam and the relationships between those costs and some demographic factors. Methods: A cross-sectional study was carried out among 359 COPD patients who visited Dong Nai General Hospital in Vietnam in 2018. Patients were classified according to codes from the International Classification of Diseases, 10th revision (ICD-10) (J44: Chronic obstructive pulmonary disease). Demographic information and clinical status of the data were illustrated by descriptive statistics. With the bootstrapping method, cost data are represented as an arithmetic mean cost (Bootstrap 95% CI). Results: The sample of this study consisted of 359 patients, of which 280 (78.0%) were outpatient department (OPD) patients compared to the 79 (22%) inpatient department (IPD) patients. Total costs per visit were estimated at $87.10 (95% CI $76.20-$99.50) and $372.10 (95% CI $320.10-$430.00) for OPD and IPD, respectively. The costs had an increasing trend with the number of comorbidities, the severity, and the duration of COPD. The annual costs were higher in men than in women, but there was a "low burden" group of OPD stage IV patients. Costs per visit of the "low burden" group were more correlated with demographic categories than those of the "high burden" group. Conclusions: The results of this perspective study illustrate that Vietnamese COPD is associated with a significant economic burden. The cost of this disease per case is shown to be proportional to the severity and comorbidities of COPD; additionally, "high burden" groups have double the total costs of COPD.


Assuntos
Assistência Ambulatorial/economia , Custos de Cuidados de Saúde , Hospitalização/economia , Doença Pulmonar Obstrutiva Crônica/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/terapia , Índice de Gravidade de Doença , Fatores Sexuais , Vietnã
11.
Med Care ; 57(8): 648-653, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31299026

RESUMO

OBJECTIVE: The objective of this study was to evaluate the impacts of the implementation of patient cost-sharing for an outpatient visit and prescription drugs for poor and nonable bodied Koreans in 2007. DATA SOURCES/STUDY SETTINGS: Nationally-representative longitudinal data sets (Korea Welfare Panel Study and the Korean Longitudinal Study of Ageing) in 2006, 2008, and 2010. RESEARCH DESIGN: Propensity score matching with difference-in-differences framework exploiting within-person variation in cost-sharing. RESULTS: Decreases in the probability of outpatient visit are offset by increases in the likelihood of hospitalization after the policy change. Cost-sharing also decreases drug adherence by 20%, particularly among chronically-ill persons. CONCLUSION: Because the costs of increased hospitalization among Medical Aid enrollees accrue to the government, the introduction of outpatient cost-sharing does not achieve the goal of cost control.


Assuntos
Assistência Ambulatorial/economia , Custo Compartilhado de Seguro , Pobreza , Idoso , Assistência Ambulatorial/organização & administração , Controle de Custos/economia , Controle de Custos/métodos , Controle de Custos/organização & administração , Custo Compartilhado de Seguro/economia , Custo Compartilhado de Seguro/métodos , Custos de Medicamentos/estatística & dados numéricos , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Adesão à Medicação/estatística & dados numéricos , Medicamentos sob Prescrição/economia , Pontuação de Propensão , República da Coreia
12.
PLoS One ; 14(5): e0217923, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150520

RESUMO

BACKGROUND: Many Western countries face the challenge of providing high-quality care while keeping the healthcare system accessible and affordable. In an attempt to deal with this challenge a new healthcare delivery model called primary care plus (PC+) was introduced in the Netherlands. Within the PC+ model, medical specialists perform consultations in a primary care setting. PC+ aims to support the general practitioners in gatekeeping and prevent unnecessary referrals to hospital care. The aim of this study was to examine the effects of a cardiology PC+ intervention on the Triple Aim outcomes, which were operationalized by patient-perceived quality of care, health-related quality of life (HRQoL) outcomes, and healthcare costs per patient. METHODS: This is a quantitative study with a longitudinal observational design. The study population consisted of patients, with non-acute and low-complexity cardiology-related health complaints, who were referred to the PC+ centre (intervention group) or hospital-based outpatient care (control group; care-as-usual). Patient-perceived quality of care and HRQoL (EQ-5D-5L, EQ-VAS and SF-12) were measured through questionnaires at three different time points. Healthcare costs per patient were obtained from administrative healthcare data and patients were followed for nine months. Chi-square tests, independent t-tests and multilevel linear models were used to analyse the data. RESULTS: The patient-perceived quality of care was significantly higher within the intervention group for 26 out of 27 items. HRQoL outcomes did significantly increase in both groups (P <0.05) but there was no significant interaction between group and time. At baseline and also at three, six and nine months' follow-up the healthcare costs per patient were significantly lower for patients in the intervention group (P<0.001). CONCLUSIONS: While this study showed no improvements on HRQoL outcomes, PC+ seemed to be promising as it results in improved quality of care as experienced by patients and lower healthcare costs per patient.


Assuntos
Assistência Ambulatorial/normas , Serviço Hospitalar de Cardiologia/normas , Cardiologia/tendências , Cardiopatias/terapia , Adulto , Assistência Ambulatorial/economia , Serviço Hospitalar de Cardiologia/economia , Feminino , Custos de Cuidados de Saúde , Cardiopatias/economia , Cardiopatias/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Pacientes Ambulatoriais , Atenção Primária à Saúde , Inquéritos e Questionários
13.
J Wound Care ; 28(6): 324-330, 2019 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-31166856

RESUMO

OBJECTIVE: To estimate the cost of wound care to the Irish health-care system. METHODS: A bottom-up, prevalence-based analysis was undertaken using a decision analytic model to estimate costs. Health-care resource activity was identified from a recently published study from the UK and was valued using unit cost data for Ireland. RESULTS: The base case analysis estimated the total annual healthcare cost of wound care to be €629,064,198 (95% Confidence interval (CI): €452,673,358 to €844,087,124), accounting for 5% (95% CI: 3% to 6%) of total public health expenditure in Ireland in 2013. The average cost per patient was €3,941 (95% CI: €2,836 to €5,287). However, this study is subject to many limitations and plausible changes in the model's inputs showed that the total annual health-care cost of wound care could range from €281,438,970 to €844,316,912. CONCLUSION: Caring for wounds places a substantial burden on the Irish health-care system. In light of growing pressures to finance an already resource-constrained health-care system, these results provide useful information for those charged with future wound care service design and provision in Ireland and elsewhere.


Assuntos
Custos de Cuidados de Saúde , Gastos em Saúde , Ferimentos e Lesões/economia , Assistência Ambulatorial/economia , Enfermagem em Saúde Comunitária/economia , Custos e Análise de Custo , Técnicas de Apoio para a Decisão , Equipamentos e Provisões/economia , Hospitalização/economia , Visita Domiciliar/economia , Humanos , Irlanda/epidemiologia , Prevalência , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia
14.
BMC Health Serv Res ; 19(1): 354, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31164130

RESUMO

BACKGROUND: We examined the utilization of rehabilitation resources among children with autism spectrum condition (ASC), a neurodevelopmental condition, in Taiwan. METHODS: We derived from the National Health Insurance Research Database of Taiwan data pertaining to 3- to 12-year-old children for the period 2008-2010. Based on diagnoses executed in accordance with the International Classification of Diseases, Ninth Revision, Clinical Modification, we classified these data into the ASC and non-ASC groups and analyzed them through multiple linear regression model, negative binomial model, independent sample t testing, and χ2 testing. RESULTS: Compared with the non-ASC group, the ASC group exhibited higher utilization of rehabilitation resources. Because hospitals are constrained by overall expenditure limits, expenditure on rehabilitation resources has plateaued, preventing any increase in the utilization of rehabilitation resources. In our ASC group, preschool-aged children significantly outnumbered (p < 0.001) school-aged children. When stratified by the hospital level, district hospitals reported the highest utilization (p < 0.001). When stratified by region, the highest utilization was in Taipei, whereas the lowest was in the East region (p < 0.001). The total annual cost, average frequency of visits, utilization of rehabilitation resources, and average cost were all affected by such elements as patient demographics, hospital type and location (p < 0.001). CONCLUSIONS: For improving treatment outcomes among children with ASC and decreasing treatment expenditure, policies that promote the timely ASC detection and treatment should be implemented.


Assuntos
Assistência Ambulatorial/economia , Transtorno Autístico , Gastos em Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/economia , Pacientes Ambulatoriais , Transtorno Autístico/economia , Transtorno Autístico/reabilitação , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Revisão da Utilização de Seguros , Masculino , Taiwan
15.
Pediatr Rheumatol Online J ; 17(1): 20, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060557

RESUMO

BACKGROUND: This study aims to describe current practice in identifying and measuring health care resource use and unit costs in economic evaluations or costing studies of juvenile idiopathic arthritis (JIA). METHODS: A scoping review was conducted (in July 2018) in PubMed and Embase to identify economic evaluations, costing studies, or resource utilization studies focusing on patients with JIA. Only English language peer-reviewed articles reporting primary research were included. Data from all included full-text articles were extracted and analysed to identify the reported health care resource use items. In addition, the data sources used to obtain these resource use and unit costs were identified for all included articles. RESULTS: Of 1176 unique citations identified by the search, 20 full-text articles were included. These involved 4 full economic evaluations, 5 cost-outcome descriptions, 8 cost descriptions, and 3 articles reporting only resource use. The most commonly reported health care resource use items involved medication (80%), outpatient and inpatient hospital visits (80%), laboratory tests (70%), medical professional visits (70%) and other medical visits (65%). Productivity losses of caregivers were much more often incorporated than (future) productivity losses of patients (i.e. 55% vs. 15%). Family borne costs were not commonly captured (ranging from 15% for school costs to 50% for transportation costs). Resource use was mostly obtained from family self-reported questionnaires. Estimates of unit costs were mostly based on reimbursement claims, administrative data, or literature. CONCLUSIONS: Despite some consistency in commonly included health care resource use items, variability remains in including productivity losses, missed school days and family borne costs. As these items likely substantially influence the full cost impact of JIA, the heterogeneity found between the items reported in the included studies limits the comparability of the results. Therefore, standardization of resource use items and unit costs to be collected is required. This standardization will provide guidance to future research and thereby improve the quality and comparability of economic evaluations or costing studies in JIA and potentially other childhood diseases. This would allow better understanding of the burden of JIA, and to estimate how it varies across health care systems.


Assuntos
Artrite Juvenil/terapia , Recursos em Saúde/estatística & dados numéricos , Assistência Ambulatorial/economia , Assistência Ambulatorial/estatística & dados numéricos , Artrite Juvenil/economia , Cuidadores/economia , Cuidadores/estatística & dados numéricos , Criança , Técnicas de Laboratório Clínico/economia , Técnicas de Laboratório Clínico/estatística & dados numéricos , Eficiência , Utilização de Instalações e Serviços , Custos de Cuidados de Saúde/estatística & dados numéricos , Recursos em Saúde/economia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos
16.
Ann Vasc Surg ; 59: 167-172, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31077768

RESUMO

BACKGROUND: We analyze the impact of outpatient telemedicine services on the travel burden of vascular surgery patients with regard to distance, time, and cost, as well as the emission of environmental pollutants. METHODS: Retrospective analysis was used to compare the patient travel expenditure and environmental impact associated with telemedicine encounters versus hypothetical in-person traditional consultations for all outpatient virtual care encounters with vascular surgery patients from October 2015 to October 2017. The primary outcomes measured were travel distance saved, travel time saved, travel costs saved, reduction in fuel consumption, and reduction in environmental pollutant emission. RESULTS: Over a two-year period, 146 outpatient telemedicine encounters were conducted among 87 unique patients (61 females, 26 males; mean age, 60 ± 13 years). The average one-way distance saved by the utilization of telemedicine services was 15.6 ± 6.3 miles, with an average roundtrip savings of 31.2 miles. The average one-way travel time saved was 19.5 ± 9.2 minutes, with an average roundtrip savings of 39 minutes. By using telemedicine services, these vascular surgery patients saved an average of $4.26 in gas and parking costs at each telemedicine encounter. The total reduction in passenger vehicle emission of environmental pollutants, including carbon dioxide, carbon monoxide, nitric oxides, and volatile organic compounds was 1632 kg, 42,867 g, 3160 g, and 4715 g, respectively, with a total of 194 gallons of gas saved from driving. CONCLUSIONS: Utilization of telemedicine services reduces the travel distance, time, and costs for vascular surgery patients. Outpatient telemedicine programs may also provide environmental benefit through the reduction of greenhouse gas and pollutant emissions.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Assistência Ambulatorial/economia , Custos de Cuidados de Saúde , Gastos em Saúde , Cuidados Pós-Operatórios/economia , Telemedicina/economia , Poluição Relacionada com o Tráfego/prevenção & controle , Transporte de Pacientes/economia , Procedimentos Cirúrgicos Vasculares/economia , Emissões de Veículos/prevenção & controle , Idoso , Assistência Ambulatorial/métodos , Redução de Custos , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Telemedicina/métodos , Fatores de Tempo
17.
Eur J Health Econ ; 20(Suppl 1): 71-78, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31102157

RESUMO

BACKGROUND: The objective of this paper is to explore unmet health care needs in Hungary in ambulatory care due to costs and difficulties in travelling, and to analyze how unmet needs relate to socio-demographic characteristics. METHODS: The quantitative analysis is based on a national, representative online survey carried out in Hungary on a sample of 1000 respondents in early 2019 using a proposed set of questions developed by the OECD. We present and compare unmet medical needs in different socio-demographic groups, and we use multivariate logistic regression analysis to identify the main determinants of unmet medical needs. RESULTS: Among responders who had medical problems in the last 12 months, 27.3% reported forgone medical visit due to difficulties in travelling, 24.2% had unfilled prescription for medicine due to costs, 21.4% reported forgone medical visit or follow-up visit due to costs and 16.6% reported skipped medical test, treatment or other follow-up due to costs. These shares are much higher than presented previously in international databases. The logistic model indicates that respondents were significantly more likely to report unmet needs if they were women, younger or belonged to first and second income quintiles. CONCLUSIONS: Policy makers need to address the issue of high prevalence of forgone medical care among the Hungarian population to avoid deterioration of population health and inequalities in access. As a first step, policies should try to decrease financial burden of vulnerable groups to improve access.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/economia , Feminino , Gastos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Hungria , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Medicamentos sob Prescrição/economia , Características de Residência , Fatores Sexuais , Fatores Socioeconômicos , Transportes , Adulto Jovem
18.
Pediatr Dermatol ; 36(3): 303-310, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30968453

RESUMO

BACKGROUND/OBJECTIVES: Atopic dermatitis (AD) is a chronic, inflammatory disease affecting both children and adults. AD is associated with multiple comorbidities and complications. In particular, AD patients are susceptible to developing cutaneous infections. Studies show that comorbidities have contributed significantly to increased health care utilization and costs in AD. However, evidence regarding the degree to which this increased health care utilization and expenditure in AD is attributable to cutaneous infections is lacking. The aim of this study was to assess the impact of skin infections on health care utilization and expenditures among patients with atopic dermatitis. METHODS: This cross-sectional study examined health care utilization and expenditures for AD patients of all ages with and without skin infections in the United States using the nationally representative 1996-2015 Medical Expenditure Panel Survey (MEPS) data. RESULTS: In this study, a total of 4 825 668 (weighted) patients had a diagnosis of AD (mean age 5.7). Of these, 776 753 patients (16%) experienced skin infections (mean age 4.4). Compared to AD patients without skin infections, those with skin infections had more frequent visits to ambulatory clinics (P = 0.001) and the emergency department (P = 0.011), and increased hospitalization (P = 0.010), after adjustments for demographic and clinical factors. AD patients with skin infections were also given 3.3 more prescriptions (P < 0.0001). AD patients with skin infections incurred significantly greater health care costs, which included an additional $351/patient/year for ambulatory visits (P < 0.0001) and an additional $177/patient/year for prescription medications (P < 0.0001). CONCLUSIONS: Atopic dermatitis patients with cutaneous infections incurred significantly greater health care utilization and expenditures than those without cutaneous infections.


Assuntos
Efeitos Psicossociais da Doença , Dermatite Atópica/economia , Dermatite Atópica/microbiologia , Custos de Cuidados de Saúde , Dermatopatias Infecciosas/complicações , Dermatopatias Infecciosas/economia , Adolescente , Adulto , Assistência Ambulatorial/economia , Criança , Pré-Escolar , Estudos Transversais , Dermatite Atópica/terapia , Serviço Hospitalar de Emergência/economia , Feminino , Gastos em Saúde , Hospitalização/economia , Humanos , Masculino , Medicamentos sob Prescrição/economia , Medicamentos sob Prescrição/uso terapêutico , Dermatopatias Infecciosas/terapia , Estados Unidos , Adulto Jovem
19.
Infect Dis (Lond) ; 51(5): 348-355, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30938200

RESUMO

BACKGROUND: In Europe few studies have analyzed the costs of treating aseptic revisions and prosthetic joint infections with either debridement, antibiotics and implant retention or two-stage revision, as compared to the cost of a primary total joint arthroplasty. METHODS: The purpose was to analyze the costs of total joint arthroplasties, aseptic revisions and prosthetic joint infections treated with debridement, antibiotics and implant retention or a two-stage revision. We conducted a retrospective cohort study of patients who had a total joint arthroplasty in the Oulu University Hospital during the three-year period from 2013 to 2015. The costs were divided to specific services (e.g. procedure costs, ward care costs, laboratory). Actual costs obtained from the hospital's financial database were used for analysis. RESULTS: There were 1708 total joint arthroplasties without complications, 18 aseptic revisions and 42 prosthetic joint infections eligible for analysis. The mean cost of a total joint arthroplasty was €7200, the excess cost of an aseptic revision was €10,900 and the excess cost of a prosthetic joint infection was €18,900 (total joint arthroplasty vs. infection, p < .0001). The excess cost was €12,800 for debridement, antibiotics and implant retention treatment and €44,600 for a two-stage revision (p < .0001). The two most expensive services were ward care and procedures. CONCLUSIONS: Infection tripled the cost of a total joint arthroplasty. The cost of two-stage revisions were triple that of debridement, antibiotics and implant retention treatment.


Assuntos
Artroplastia do Joelho/economia , Custos Hospitalares , Infecções Relacionadas à Prótese/economia , Infecções Relacionadas à Prótese/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/economia , Antibacterianos/economia , Antibacterianos/uso terapêutico , Desbridamento , Feminino , Finlândia , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/tratamento farmacológico , Estudos Retrospectivos , Adulto Jovem
20.
Asia Pac J Public Health ; 31(3): 210-218, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30961350

RESUMO

Out-of-pocket expenditure/payment (OOP) is one of the indicators measuring the achievement of Universal Health Coverage. This article aimed to compare OOP among the insured and uninsured for their outpatient and inpatient health care services. The data of 6710 individuals using outpatient care and 924 individuals using inpatient care at 78 district hospitals and 246 commune health centers in 6 provinces from the World Bank survey, "The 2015 Vietnam District and Commune Health Facility," were used for analysis. In the ordinary least square model, the estimated coefficient of the insurance status variable suggested that insurance reduced OOP by 31.1% for outpatient care and 31.5% for inpatient care of the insured as compared with the uninsured (P <0.001). For outpatient care, insurance reduced OOP more for those enrollees using commune health centers than those using district health facilities, 42.3% and 20.2%, respectively. For inpatient care at district health facilities, insurance reduced OOP by 34.9% as compared with the uninsured (P <0.001). The study suggested that more active solutions should be created to promote the universal health insurance in Vietnam.


Assuntos
Assistência Ambulatorial/economia , Gastos em Saúde/estatística & dados numéricos , Hospitalização/economia , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Cobertura Universal do Seguro de Saúde , Vietnã , Adulto Jovem
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